A Patient Guide to Understanding Brain Stimulation Options for Treatment-Resistant Depression
Key Takeaway: When depression doesn’t improve enough with medication or therapy, your healthcare provider may recommend a treatment that works by directly stimulating areas of the brain involved in mood. Two options are repetitive Transcranial Magnetic Stimulation (rTMS) and Electroconvulsive Therapy (ECT). Both treatments can help people living with difficult-to-treat depression, but the experience of receiving them is quite different.
What is ECT?
Electroconvulsive Therapy, or ECT, uses a carefully controlled electrical current to cause a brief seizure in the brain. The treatment is performed under general anesthesia, so you are asleep during the procedure.
ECT is typically given two to three times per week for several weeks. Because anesthesia and medical monitoring are required, treatment takes place in a hospital or specialized medical setting. ECT has been used for many years and can be particularly effective for severe depression, especially when symptoms need to improve quickly.
What is rTMS?
Repetitive Transcranial Magnetic Stimulation, or rTMS, works differently. Instead of using an electrical current or causing a seizure, TMS uses magnetic pulses to stimulate specific areas of the brain involved in mood regulation. During treatment, a magnetic coil is placed against the scalp while you sit comfortably in a treatment chair. You remain awake throughout the session, and there is no anesthesia or sedation required.
A typical session lasts around 30 minutes. Afterward, most people can return to their usual activities, including driving and working.
Which Treatment is More Effective?
Both TMS and ECT can improve symptoms of depression, but research generally finds that ECT produces higher short-term response and remission rates. In the research reviewed by Thurstan and Hyland (2025), approximately 64% of patients responded to ECT, compared with about 49% receiving high-frequency TMS. Remission rates were approximately 53% for ECT and 32% for high-frequency TMS.
ECT can therefore be especially important when depression is very severe or when improvement is needed quickly. This may include situations involving severe suicidal thoughts, catatonia, or depression with psychotic symptoms. However, effectiveness is only one part of choosing a treatment. Side effects, medical needs, lifestyle, and personal preferences also matter.
What About Side Effects?
One of the biggest differences between ECT and TMS is how treatment may affect your daily life. Because ECT requires anesthesia, patients need additional medical monitoring and recovery time. Some people may also experience temporary confusion or memory difficulties, particularly around the time of treatment.
TMS does not require anesthesia and is generally well tolerated. The most common side effects are temporary scalp discomfort or headaches, which often improve as the body becomes accustomed to treatment. This can make TMS easier to fit into everyday life. Many patients receive treatment and then continue with the rest of their day as usual.
So, Which One Should You Choose?
There isn’t one treatment that is right for everyone.
- ECT may be recommended when symptoms are extremely severe and rapid improvement is medically necessary. It has strong evidence for severe depression, including depression with psychotic symptoms.
- TMS may be an option for people with treatment-resistant depression who want a non-invasive outpatient treatment without anesthesia. It can also be appealing for people who want to continue working, driving, or maintaining their usual routine throughout treatment.
Ultimately, the decision should be made with a qualified healthcare professional who can consider your symptoms, treatment history, medical needs, and personal preferences.
Reference
Thurstan, Z., & Hyland, D. (2025). A Comparison of the Efficacy of Electroconvulsive Therapy and Transcranial Magnetic Stimulation in the Treatment of Depressive Disorder – Is One Better Than the Other? BJPsych Open, 11(S1), S40. https://doi.org/10.1192/bjo.2025.10140
If you are considering treatment for depression, speak with a qualified healthcare professional about which option may be appropriate for you. You can also contact Bloom rTMS to learn whether rTMS could be a fit for your care plan.